11 May Health technology at home: putting the power in the patient’s hands
Editor’s Note: Patti Brennan spoke at WTN Media’s Digital Healthcare Conference on the topic of “Hi-Tech Health@Home: New Center of Healthcare Delivery”. Click here to view his presentation.
MADISON – People don’t like disembodied voices reminding them to take medicine.
This is just one of the lessons those studying home-based health informatics have learned as they develop new tools to help patients and clinicians improve health care delivery.
Patti Brennan, a professor at the University of Wisconsin-Madison described as an authority in the field of health informatics, spoke on the emerging field of home-health information technology at the seventh annual Digital Healthcare Conference 2009 last week. In her talk, “Hi-tech Health@Home: New Center of Healthcare Delivery,” Brennan stressed that, “if we truly want to get the power of healthcare in the hands of people and have them use health information technology, we need to think about people where they are.”
To deliver health IT where people live, Brennan said it’s essential to know something about the home environment from a multitude of facets from living conditions to the social, technological, psychological and health service options. It’s important to learn what the household is like, whose in charge of health information, who plays the main nursing role in the home?
“We’re not talking about wired and wealthy (homes), but where technology serves a purpose in health. What tools might be useful to people as they face health care in homes?” Brennan explained.
Brennan, a professor in the Nursing School and current chair of the Department of Industrial and Systems Engineering in the College of Engineering, leads a team based at the UW-Madison School of Nursing studying just this. Project HealthDesign, is a national program working to spur innovation in personal health information technology. The program last week announced that it was awarded $5.3 million from the Robert Wood Johnson Foundation, bringing the project’s total funding to $10 million. The project, which will extend to 2012 with this new funding, is now seeking proposals from up to five teams that will work on showing how to help patients with chronic illnesses improve their health by helping them record, understand and act on information they record about their daily lives.
These observations of daily living, or ODLs, are thought to be the key to designing effective health 2.0 tools. But because people are not apt to keep a daily health journal or log of habits and behaviors to populate an ODL data bank, Brennan said the project is focusing on creating innovative ways to capture this information noting that, “These are all cool tools. But you can’t sell health by just having cool tools. We have to have an understanding of the daily lives of individuals.”
What could these capture tools possibly look like down the road? Brennan described smart clothing that monitor critical health indicators, or carpeting with sensors that will recognize a change in a person’s cadence – an early sign of confusion and cognitive ailment. Air sensors and other environmental tools could monitor for pollen density in homes. Technology is now available to enable robotics and smart appliances to help elderly or bedridden people get proper medicine. Tools can be mobile, such as a portable health diary, a key fob that would prompt and encourage exercise, or cell phone application that captures food intake and connects to medical records.
Tim Herr of Epic Systems Corp. in Verona asked about systems like the Wii Fit in relation to capturing patient data. Brennan said that the popularity of consumer electronic devices such as the iPhone, iPod and even gaming systems like the Wii could provide the so-called “killer ap” that will drive patient adoption of data-capture devices. One project at the Robert Wood Johnson Foundation called Games for Health is exploring the idea of incorporating gaming into data collection.
But there are challenges, she said, in monitoring and reporting the data in stream, and figuring out what the data means
“We believe in the three-legged stool of technology based health of the future,” Brennan explained. “Tools reside with the individual and are part of the environment; there are places where data can be stored and integrated and then clinical information systems. Finding ways to share date across these sites and developing interoperability and mapping tools are a three to five year strategy.”
The idea behind ODLs is fascinating, said conference attendee Norma Tirado, senior vice president of employee and information services at Agnesian HealthCare in Fond du Lac, moving consumers to the next level of responsibility for their own choices and their own health.
“My concern is how do we communicate that back to the records we have. There’s so much information,” Tirado said. “And what we see may be different than what we already view as relevant information.”
Indeed, Brennan said there are challenges ahead in sifting through processes to not only collect this information, but deliver it in a relevant way to clinicians. To make it happen, factors such as environmental readiness have to be considered. Devices developed have to conform to some standard so they can all feed into a clinical system. People need to be trained, perhaps starting as early as Kindergarten, to think about taking an active part in their own health. Trusted communication methods have to be developed in ways that transmit information in valid, secure ways.
And, there has to be thought given to the shift in accountability for health care decision-making. Questioned Brennan, “What happens when a patient is not in the room? How do we make decisions?”
Going forward, Brennan said the future development of healthcare IT in the home is guided by principals that promote dignity, autonomy and well being in communities and envision moving beyond industrial services and more toward patient activation and engagement.
“How do we balance action, information and data capture for clinical reporting and, finally, how do we build in privacy and control,” asked Brennan.
To make it happen, it will require many people working on innovative systems for institutions and homes.
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